Inpatients with a foot wound undergoing revascularisation surgery, what is the time frame for improvement in toe systolic pressures? A pilot study

Mrs Elise Gillies1, Miss Jaspreet Kaur 1Kate Waller1, Franklin Pond1, Anthony Chan1

1Northern Health, Epping, Australia

Aim: The Toe Systolic Pressure (TP) and Ankle Brachial Index (ABI) are non-invasive tests used in the assessment of peripheral arterial disease (PAD). They are also used to evaluate the magnitude of improvement of revascularisation in people who undergo surgical procedures to improve their peripheral arterial supply. A TP will give clinical information as to the arterial potential for wound healing. The aim of this study is to determine the time period it takes for TP to be maximised following revascularisation surgery in people with a foot wound.

Method: Demographic data of consenting patients admitted to The Northern Hospital (TNH) with a foot wound undergoing a revascularisation procedure was collected. NH Podiatry staff performed TP prior to revascularisation and then again at day 1, 3, 7 and 14 post revascularisation, to monitor the progression of the patient’s lower limb arterial perfusion.

Results: A total of 21 patients undergoing 22 vascular interventions were included in this study. 42.8% (n=9) patients were female. Average age was 68.2 (range 52-86). 90.5% (n=20) patients had history of DM and 9.5% (n=2) with nil history of diabetes mellitus. Median time frame for improvement in TP post revascularization was 3.0 days (IQR 1.5-12.3 days).

Significance of findings: Based on the outcomes of this study, we can inform podiatrists and wound care specialists with knowledge to make clinical recommendations regarding timing of some wound management practices, as 3 days post revascularisation. If a clinician is able to provide clinical advice regarding when arterial perfusion is likely to be optimised, they may be able to prevent surgical intervention (debridement or amputation), by initiating moist wound healing principles and facilitate earlier patient discharge from hospital.